Growth Plate Injuries

(Epiphysiolysis)

dr. Igin Ginting Sp.OT. Mkes

Basic Osseous Anatomy

Epiphysis Secondary Ossification

Center

The epiphysis is the bone located between the articular surface and the physis

Epiphyseal Plate = Growth Plate = Physis

Metaphysis Bone adjacent to the

physis on the opposite side of the epiphysis.

Diaphysis The shaft of the bone

OTA Compendium

Growth Plate Histology

Zones of the Physis

Germinal Zone

Minimally active, scattered chondrocytes

Proliferative Zone

Columns of chondrocytes actively dividing

Hypertrophic Zone

Chondrocytes accumulate and release calcium

Weakest zone of physis

Zone of endochondral ossification

Other Important Growth

Factors Location Average

Growth

(mm/yr)

Percentage of bone

Longitudinal Growth

Proximal Humerus 7mm 80%

Distal Humerus 2mm 20%

Proximal Radius 1.75mm 25%

Distal Radius 5.25mm 75%

Proximal Ulna 5.5mm 80%

Distal Ulna 1.5mm 20%

Proximal Femur 3.5mm 30%

Distal Femur 9mm 70%

Proximal Tibia 6mm 60%

Distal Tibia 3-5mm 40%

Epidemiology

18% to 30% of children’s fractures involve the

physis

Male-to-female ratio is about 2:1

Most common site is phalanges of the fingers

(~40%)

Distal radius (18%)

Distal Tibia (11%)

Distal Fibula (7%)

Mechanism of Injury

Shearing

Avulsion

Spliting

Crushing

Fracture Classification

Salter-Harris most commonly used

Multiple historical classification systems

Poland

Bergenfeldt

Aitken

Peterson

Salter-Harris Classification

• Menurut Salter dan Haris dibagi 5 tipe :

I : Terlepasnya epiphyse dari metaphyse tanpa terjadinya fraktur

II : Terbentuklah suatu segitiga pada metaphyse disebut

“Thurston Holland Sign”

III : Fraktur intra artikuler yang dimulai dari sendi ke arah

garis epiphyse yang menembus ke arah tepi.

IV : Terjadi fraktur intraartikuler yang menembus permukaan

epiphyse dan metaphyse

V : Cedera kompresi longitudinal pada epiphyse

Salter-Harris Classification

Salter-Harris General

Frequency

13% 54% 11% 6% 16%

Imaging

Plain radiographs

Concerning radiographs or

history:

Comparison xrays

CT Scan

MRI

Importance of Prior Xray

Views

Child with knee

pain

Difficult to see

fracture

displacement

Oblique Xray

Shows significantly

displaced fracture

Advanced Imaging

Fracture displacement difficult to assess and measure

Advanced Imaging

CT scan shows a Salter

Harris III fracture of the

distal tibia

Displacement can be

measured easily

Principles of Treatment

Fracture healing with maintenance of

growth potential

Acceptable reduction and alignment

Limit iatrogenic injury to physis

Repeated, forceful reduction attempts

Hardware across physis

Maintenance of reduction/alignment

Treatment options :

• Treatment options include:

• Closed reduction and casting

• Closed reduction and

percutaneous screw or wire

fixation

• Screw for larger metaphyseal

fragment

• Wires crossing physis for

smaller metaphyseal fragment

Complication

Longitudinal bone growth ceases

completely at that physis ( arrest )

Angular deformity associated with

shortening

Malunion

Thank You